Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm

Yamashina, Takeshi; Takeuchi, Yoji; Uedo, Noriya; Hamada, Kaoru; Aoi, Kenji; Yamasaki, Yasushi; Matsuura, Noriko; Kanesaka, Takashi; Akasaka, Tomofumi; Yamamoto, Sachiko; Hanaoka, Noboru; Higashino, Koji; Ishihara, Ryu; Iishi, Hiroyasu

doi:10.1111/jgh.13052

Cited by 91 publications

(120 citation statements)

References 31 publications

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“…[1][2][3] However, incomplete resection of polyps sometimes occurs and may lead to interval cancer. 6,7 Even without electrocautery, the incomplete resection rate with CSP is not high-a 3.9% incomplete resection rate. 6,7 Even without electrocautery, the incomplete resection rate with CSP is not high-a 3.9% incomplete resection rate.…”

Section: Introductionmentioning

confidence: 99%

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Shichijo

Takeuchi

Kitamura

et al. 2019

J of Gastro and Hepatol

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Background and Aim The true incidence of incomplete muscularis mucosa resection with cold snare polypectomy (CSP) is unknown. We examined the incidence of incomplete muscularis mucosa resection both with and without cold snare defect protrusion (CSDP). Methods We prospectively enrolled patients undergoing polypectomy for 4 to 9mm nonpedunculated polyps. We evaluated the presence of CSDP immediately following CSP and biopsied the CSDP or the center of the mucosal defect without CSDP. The presence of the muscularis mucosa and any residual polyp in the biopsies was evaluated histologically. The primary outcome was the incidence of incomplete mucosal layer resection defined as the presence of muscularis mucosa or residual polyp in the biopsies. Results From August 2017 to October 2018, 188 patients were screened, and 357 polyps were included. CSDP was detected in 122/355 (34%) evaluated mucosal defects. Excluding five lesions requiring hemostasis immediately following CSP, 352 mucosal defects were biopsied. After excluding 102 biopsies containing normal mucosa, we evaluated 250 biopsies. The overall incidence of incomplete mucosal layer resection was 63% (159/250), 76% (68/90) with CSDP and 57% (91/159) without CSDP (P < 0.01). Both univariate and multivariate analyses showed that size (≥ 6 mm), resection time (≥ 5 s), and serrated lesions were risk factors for CSDP. Conclusions Cold snare defect protrusion (CSDP), which was present with 36%, was a good indicator for incomplete mucosal layer resection. Even in nonCSDP polypectomies, 57% of the mucosal layer was not removed completely. Thus, CSP should be used for intra‐epithelial lesions only, and careful pretreatment evaluation is recommended.

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Section: Introductionmentioning

confidence: 99%

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Shichijo

Takeuchi

Kitamura

et al. 2019

J of Gastro and Hepatol

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“…Also, the majority of delayed perforations occurred within 2 days of ESD for right-sided lesions. It also well-known that a right-sided lesion is also a risk factor for post-ESD coagulation syndrome (PECS), characterized by localized abdominal pain, signs of peritoneal irritation and fever, in the absence of a frank perforation either during or after ESD [17]. A randomized controlled trial provided evidence of a decrease in the risk of PECS with closure of mucosal defects after colorectal endoscopic resection using endoclips [25].…”

Section: Discussionmentioning

confidence: 99%

“…Between February 2011 and January 2012, all patients received antibiotics over the first 2 post-operative days. However, after February 2012, antibiotic therapy was only administered by the attending physician as needed, due to the absence of strong evidence regarding the efficacy of prophylactic antibiotics for the prevention of postoperative infection [16,17]. Emergency surgery was basically performed when a patient showed signs of panperitonitis: rebound, involuntary guarding, and percussion tenderness on the entire abdomen.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

Iwatsubo

Takeuchi

Yamasaki

et al. 2018

Dig Dis

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Background: Although the use of endoscopic submucosal dissection (ESD) as a minimally invasive treatment for large superficial colorectal neoplasms is increasing, colorectal ESD remains technically challenging. As perforation in the colorectum is generally considered to be associated with a higher risk of complications, the aim of this study was to investigate the characteristics of perforation caused by colorectal ESD. Methods: This retrospective study included 635 lesions treated with colorectal ESD, between February 2011 and December 2015, in a tertiary cancer center. We evaluated and compared the clinical course and short-term outcomes of the intraprocedural perforation group with those of the delayed perforation and no perforation groups. Results: Perforation occurred in 45 (7.1%) of the 635 cases. Thirty-six cases were intraprocedural perforation (5.7%), all of which were successfully closed with endoclips during the procedure. Nine cases of delayed perforation occurred (1.4%). No emergency surgery was performed in the intraprocedural perforation group; however, 5 of 9 cases underwent emergency surgery in the delayed perforation group (56%, p < 0.0001). There were statistically significant differences between the intraprocedural and delayed perforation groups with regard to the hospitalization period, fasting period, abdominal pain scale, peak white blood cell (WBC) count, and peak C-reactive protein (CRP), and between the intraprocedural and no perforation groups with regard to the location of the lesion, hospitalization period, fasting period, abdominal pain scale, peak WBC, peak CRP, and en bloc resection rate. Conclusions: While intraprocedural perforation due to colorectal ESD can be managed conservatively, delayed perforation can lead to serious adverse events.

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“…Procedure time was measured from the start to fill the lumen with physiological saline until complete closure was achieved. Delayed adverse events were defined as in previous reports [5,10,11].…”

Section: Patientsmentioning

confidence: 99%

“…However, we sometimes encounter adverse events related to C-ESD, including delayed bleeding (2-3%), intraoperative perforation (2-5%), delayed perforation (0.4%), and post-ESD coagulation syndrome (9%) [1][2][3][4][5]. Almost all intraoperative perforations can be closed endoscopically using conventional clips and cured conservatively [2], but the prophylaxis for, and management of, delayed adverse events have not yet been fully DOI: 10.1159/000492815 established.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Underwater Clip Closure for Large Mucosal Defects after Colorectal Endoscopic Submucosal Dissection

et al. 2018

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Background/Aims: Clip closure of mucosal defects after colorectal endoscopic submucosal dissection (C-ESD) may decrease the incidence of delayed adverse events. The size of the defect to be closed by conventional clip is limited, however, and we sometimes encounter incomplete closure when the defect is located at the flexure. As, theoretically, underwater clip closure (UCC) could achieve complete closure despite these difficult cases, we investigated its feasibility. Methods: We retrospectively analyzed 21 patients who underwent UCC after C-ESD. The main outcome was the UCC success rate, defined as complete closure of the defect. Other outcomes were procedure time, number of clips, and the delayed adverse event rate. Results: The median resected specimen size was 31 mm (range 18–47 mm). The UCC success rate was 100%. The median procedure time was only 11 min (range 6–21 min). The median number of clips was 9 (range 5–16). No delayed adverse event occurred. Conclusion: It is feasible to use UCC to close large mucosal defects, although further studies are warranted to assess its efficacy.

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Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm

Abstract: Occurred in 32 patients (9.5%) with colorectal ESD; however, all cases had a good outcome with conservative management. Female sex, tumor location at the ascending colon and cecum, and resected specimen ≥40 mm were independently significant risk factors for PECS.

Cited by 91 publications

References 31 publications

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

Feasibility of Underwater Clip Closure for Large Mucosal Defects after Colorectal Endoscopic Submucosal Dissection

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